Posts filed under ‘Desinfection and Sterilization’

Staphylococcus lugdunensis, a serious pathogen in periprosthetic joint infections: comparison to Staphylococcus aureus and Staphylococcus epidermidis.

Int J Infect Dis. Oct. 2016 V.51 P56-61.

Lourtet-Hascoët J1, Bicart-See A2, Félicé MP3, Giordano G4, Bonnet E2.

Author information

1 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France. Electronic address: julielourtet@hotmail.com

2 Infectious Diseases Mobile Unit, J. Ducuing Hospital, Toulouse, France.

3 Microbiological Laboratory, Hôpital J. Ducuing, 15 rue Varsovie, 31300 Toulouse, France.

4 Traumatology and Orthopaedic Surgery Department, J. Ducuing Hospital, Toulouse, France.

Abstract

OBJECTIVES:

The aim of this study was to assess the characteristics of periprosthetic joint infection (PJI) due to Staphylococcus lugdunensis and to compare these to the characteristics of PJI due to Staphylococcus aureus and Staphylococcus epidermidis.

METHODS:

A retrospective multicentre study including all consecutive cases of S. lugdunensis PJI (2000-2014) was performed. Eighty-eight cases of staphylococcal PJI were recorded: 28 due to S. lugdunensis, 30 to S. aureus, and 30 to S. epidermidis, as identified by Vitek 2 or API Staph (bioMérieux).

RESULTS:

Clinical symptoms were more often reported in the S. lugdunensis group, and the median delay between surgery and infection was shorter for the S. lugdunensis group than for the S. aureus and S. epidermidis groups. Regarding antibiotic susceptibility, the S. lugdunensis strains were susceptible to antibiotics and 61% of the patients could be treated with levofloxacin + rifampicin. The outcome of the PJI was favourable for 89% of patients with S. lugdunensis, 83% with S. aureus, and 97% with S. epidermidis.

CONCLUSION:

S. lugdunensis is an emerging pathogen with a pathogenicity quite similar to that of S. aureus. This coagulase-negative Staphylococcus must be identified precisely in PJI, in order to select the appropriate surgical treatment and antibiotics .

PDF

http://www.ijidonline.com/article/S1201-9712(16)31132-8/pdf

June 20, 2017 at 7:44 pm

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study.

BMC Infect Dis. May 2, 2017 V.17 N.1 P.321.

Leijtens B1, Elbers JBW2, Sturm PD3, Kullberg BJ4, Schreurs BW2.

Author information

1 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. borg.leijtens@radboudumc.nl.

2 Department of Orthopaedic Surgery, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.

3 Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands.

4 Department of Internal Medicine and Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.

Abstract

BACKGROUND:

Staphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.

METHODS:

In this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months. Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.

RESULTS:

In this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.

CONCLUSION:

Combined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5414295/pdf/12879_2017_Article_2429.pdf

June 20, 2017 at 7:11 pm

Use of Chlorhexidine Preparations in Total Joint Arthroplasty.

J Bone Jt Infect. 2017 Jan 1;2(1):15-22.

George J1, Klika AK1, Higuera CA1.

Author information

1 Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, OH, USA.

Abstract

Prosthetic joint infection (PJI) is a serious complication after total joint arthroplasty (TJA). Chlorhexidine is a widely used antiseptic because of its rapid and persistent action. It is well tolerated and available in different formulations at various concentrations. Chlorhexidine can be used for pre-operative skin cleansing, surgical site preparation, hand antisepsis of the surgical team and intra-articular irrigation of infected joints. The optimal intra-articular concentration of chlorhexidine gluconate in irrigation solution is 2%, to provide a persistent decrease in biofilm formation, though cytotoxicity might be an issue. Although chlorhexidine is relatively cheap, routine use of chlorhexidine without evidence of clear benefits can lead to unnecessary costs, adverse effects and even emergence of resistance. This review focuses on the current applications of various chlorhexidine formulations in TJA. As the treatment of PJI is challenging and expensive, effective preparations of chlorhexidine could help in the prevention and control of PJI.

PDF

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423571/pdf/jbjiv02p0015.pdf

June 20, 2017 at 2:21 pm

Two Cases of Legionnaires’ Disease in Newborns After Water Births — Arizona, 2016

Morbidity and Mortality Weekly Report June 9, 2017 / 66(22);590–591

Geoffrey Granseth, MPH1,2; Rachana Bhattarai, MS1; Tammy Sylvester, MSN3; Siru Prasai, MD3; Eugene Livar, MD1

1Arizona Department of Health Services; 2CDC/CSTE Applied Epidemiology Fellowship Program; 3Maricopa County Department of Public Health, Arizona.

Legionnaires’ disease is a severe, sometimes fatal disease characterized by fever, myalgia, cough, and clinical or radiographic pneumonia, caused by inhaling or aspirating small droplets of water containing Legionella bacteria.* In 2015, approximately 6,000 cases of Legionnaires’ disease were reported in the United States (1). Nearly 10% of cases are fatal (2). The number of reported cases of Legionnaires’ disease in Arizona has increased in recent years. Surveillance data from Arizona’s Medical Electronic Disease Surveillance Intelligence System (MEDSIS) identified 46 reported cases in 2011 and 93 in 2015 (3), representing more than a 100% increase. During 2011–2015, only one case was reported in an infant aged <1 month; however, during the first 4 months of 2016, two cases were reported in infants, both of whom were delivered at home in a birthing tub (water births)…..

PDF

https://www.cdc.gov/mmwr/volumes/66/wr/pdfs/mm6622a4.pdf

 

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June 12, 2017 at 7:54 am

Gram-negative prosthetic joint infections: risk factors and outcome of treatment.

Clin Infect Dis. 2009 Oct 1;49(7):1036-43

Hsieh PH, Lee MS, Hsu KY, Chang YH, Shih HN, Ueng SW.

Department of Orthopedic Surgery, Chang Gung Memorial Hospital, No. 5, Fu-Hsing St., 333 Kweishian, Taoyuan, Taiwan. hsiehph@adm.cgmh.org.tw

BACKGROUND:

Little information is available regarding the demographic characteristics and outcomes of patients with prosthetic joint infection (PJI) resulting from gram-negative (GN) organisms, compared with patients with PJI resulting from gram-positive (GP) organisms.

METHODS:

We performed a retrospective cohort analysis of all cases of PJI that were treated at our institution during the period from 2000 through 2006.

RESULTS:

GN microorganisms were involved in 53 (15%) of 346 first-time episodes of PJI, and Pseudomonas aeruginosa was the most commonly isolated pathogen (21 [40%] of the 53 episodes). Patients with GN PJI were older (median age, 68 vs. 59 years; P<.001) and developed infection earlier (median joint age, 74 vs. 109 days; P<.001) than those with GP PJI. Of the 53 episodes of GN PJI, 27 (51%) were treated with debridement, 16 (30%) with 2-stage exchange arthroplasty, and 10 (19%) with resection arthroplasty. Treating GN PJI with debridement was associated with a lower 2-year cumulative probability of success than treating GP PJI with debridement (27% vs. 47% of episodes were successfully treated; P=.002); no difference was found when a PJI was treated with 2-stage exchange or resection arthroplasty. A longer duration of symptoms before treatment with debridement was associated with treatment failure for GN PJI, compared with for GP PJI (median duration of symptoms, 11 vs. 5 days; P=.02).

CONCLUSIONS:

GN PJI represents a substantial proportion of all occurrences of PJI. Debridement alone has a high failure rate and should not be attempted when the duration of symptoms is long. Resection of the prosthesis, with or without subsequent reimplantation, as a result of GN PJI is associated with a favorable outcome rate that is comparable to that associated with PJI due to GP pathogens.

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/49/7/10.1086/605593/2/49-7-1036.pdf?Expires=1491958662&Signature=IxAKWF6-WgKZaPGD72JDtgQ9EfZuwpmNFPVdR-BdK33eRJu1GUZJXyCJ7ri9ZaJ-a4T2iy6Mj1nesDu5OTWvIfp2j5XaVprK679YVFFTXrSfwHRKFO8JDumpQWlBnByaEbCEsj~ky9lFBC~~2xrpArBj31INcTvo1vLo5sICnAjdiELud-7DVPsbupIMI7ZE3HJiWJFNiP8FGIgyiCEeD2EhGUieinh7IbChHW6tjzh5v-AIB1LCiQzHPaVo8QPMbu9HH7ggA0JlS7YXjwhwJJfdjYU4pgWxeBL9p464aVUmZWotZzoN-lNM46Wyryl4U1xrPETeCZOVC1u8fGMdNQ__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

April 7, 2017 at 10:07 pm

Are hospital floors an underappreciated reservoir for transmission of health care-associated pathogens?

American Journal of Infection Control March 1, 2017 V.45 N.3 P.336-338

Abhishek Deshpande, MD, PhD, Jennifer L. Cadnum, BS, Dennis Fertelli, BS, Brett Sitzlar, BS, MPH, Priyaleela Thota, MD, Thriveen S. Mana, MS, MBA, Annette Jencson, MT, CIC, Heba Alhmidi, MD, Sreelatha Koganti, MD, Curtis J. Donskey

Highlights

  • Patient room floors in 5 hospitals were often contaminated with health care-associated pathogens.
  • It was not uncommon for high-touch objects to be direct contact with the floor.
  • Touching objects on the floor frequently resulted in transfer of pathogens to hands.
  • Floors in hospital rooms could be an underappreciated source for pathogen dissemination.

 

In a survey of 5 hospitals, we found that floors in patient rooms were frequently contaminated with pathogens and high-touch objects such as blood pressure cuffs and call buttons were often in contact with the floor. Contact with objects on floors frequently resulted in transfer of pathogens to hands.

PDF

http://www.ajicjournal.org/article/S0196-6553(16)31014-8/pdf

March 10, 2017 at 7:43 am

Propionibacterium acnes: Disease-Causing Agent or Common Contaminant? Detection in Diverse Patient Samples by Next-Generation Sequencing

Journal of Clinical Microbiology April 2016 V.54 N.4 P.980-987

Sarah Mollerup, Jens Friis-Nielsen, Lasse Vinner, Thomas Arn Hansen, Stine Raith Richter, Helena Fridholm, Jose Alejandro Romero Herrera, Ole Lund, Søren Brunak, Jose M. G. Izarzugaza, Tobias Mourier, Lars Peter Nielsen, and Anders Johannes Hansen

aCentre for GeoGenetics, Natural History Museum of Denmark, University of Copenhagen, Copenhagen, Denmark

bCenter for Biological Sequence Analysis, Department of Systems Biology, Technical University of Denmark, Kongens Lyngby, Denmark

cDisease Systems Biology Program, Panum Institute, University of Copenhagen, Copenhagen, Denmark

dDepartment of Autoimmunology and Biomarkers, Statens Serum Institut, Copenhagen S, and Aalborg University, Health Sciences, Aalborg, Denmark

Propionibacterium acnes is the most abundant bacterium on human skin, particularly in sebaceous areas. P. acnes is suggested to be an opportunistic pathogen involved in the development of diverse medical conditions but is also a proven contaminant of human clinical samples and surgical wounds.

Its significance as a pathogen is consequently a matter of debate. In the present study, we investigated the presence of P. acnes DNA in 250 next-generation sequencing data sets generated from 180 samples of 20 different sample types, mostly of cancerous origin.

The samples were subjected to either microbial enrichment, involving nuclease treatment to reduce the amount of host nucleic acids, or shotgun sequencing. We detected high proportions of P. acnes DNA in enriched samples, particularly skin tissue-derived and other tissue samples, with the levels being higher in enriched samples than in shotgun-sequenced samples.

P. acnes reads were detected in most samples analyzed, though the proportions in most shotgun-sequenced samples were low. Our results show that P. acnes can be detected in practically all sample types when molecular methods, such as next-generation sequencing, are employed.

The possibility of contamination from the patient or other sources, including laboratory reagents or environment, should therefore always be considered carefully when P. acnes is detected in clinical samples.

We advocate that detection of P. acnes always be accompanied by experiments validating the association between this bacterium and any clinical condition.

PDF

http://jcm.asm.org/content/54/4/980.full.pdf

March 9, 2017 at 3:35 pm

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